Monday, July 28, 2008

**This report was previously excerpted in the July edition of our newsletter.**

Overshadowed by its final days of an attempted legislator pay raise and statewide voter indignation, the 2008 Regular Session of the Louisiana Legislature’s pursuit of state healthcare policy and delivery was remarkably subdued in contrast.

This comes somewhat as a surprise, especially considering both the election of several new and seemingly more conservative legislators for this session because of term limits, as well as a new governor whose major policy orientation as well as professional history hallmarks the private provision of healthcare. Indeed, the 84-day session was most notable for its avoidance of conflict and the paucity of sweeping healthcare initiatives.

Governor Bobby Jindal’s seemingly solid endorsement of the primacy of the LSU-run state Charity Hospital system dismayed conservative and corporate allies who thought that their healthcare redesign proposals towards vouchers for the purchase of private insurance for the poor and uninsured would find a champion in Jindal. Instead the redesign proponents now find themselves virtually irrelevant – belying what was thought of by them as well as feared by Charity Hospital advocates as a slam dunk in their dreams of transforming healthcare delivery and putting the final stakes in the heart of Louisiana’s unique New Deal-era healthcare system.

Proponents of the resurrection of New Orleans’ Avery C. Alexander Charity Hospital continued to receive mixed legislative support. Senator Julie Quinn (R-Metairie) started the session off on a great note however, by virtually demanding an investigation as to why Big Charity (as the New Orleans flagship facility is fondly known) wasn’t reopened after Hurricane Katrina. Community advocates (including this writer) demanded during the same legislative hearing March 25 again why an independent inspection of the facility hadn’t commenced, two years after the state legislature mandated it under HCR 89.

Reaction at once propelled the launch of the independent inspection process (for details go to http://www.FHL.org ) while also ignoring calls for prompt action to fulfill the other part of the 2006 unanimous state legislative call – to reopen Big Charity on an interim basis. Thought-to-be sympathetic legislative allies such as Senator Cheryl Gray (D-New Orleans) and Representative Juan LaFonta (D-New Orleans) publicly eschewed any ideas that such a prospect would be possible or even worthwhile, even as litigation to challenge the closure of Big Charity proceeded to yield legal dividends.

The few legislative attempts to dismantle or diminish the Charity Hospital system and discourage its indigent patients nevertheless met with swift defeat. House Health and Welfare Vice-Chair John LaBruzzo (R-Metairie) authored two bills, HB 808 and HB 919, which sought to dismantle and de-fund the Charity Hospital system by shifting assets towards local hospital service districts. In addition he had authored a bill to limit medical malpractice claims to people who paid for healthcare through insurance, effectively excluding the poor and uninsured. Dubbed ‘Be Wealthy or Be Well’ by Times-Picayune columnist James Gill, this latter bill emerged from committee stripped of most of its provisions and warped into just denying claims to undocumented immigrants! By the time of its emergence in the Senate, HB 887 died a quiet death – just like LaBruzzo’s direct Charity Hospital system attack bills, neither of which made it out of committee.

The one legislative flashpoint concerning Charity Hospital system care and funds involved SB 402, authored by Senator Bill Cassidy (R-Baton Rouge), which called for the reallocation of uncompensated care payments towards a more equalized system sharing. An Earl K. Long Charity Hospital physician, Cassidy charged that New Orleans’ Medical Center of Louisiana (encompassing the shuttered Big Charity and the reopened University Hospital) receives a dominant amount of Disproportionate Share (DSH) payments in comparison with other LSU Health Science Center-New Orleans-run hospitals, reportedly over $3000 per uninsured patient in New Orleans versus about $900 each in Baton Rouge and just over $1000 per patient in Houma and Lafayette.

The implications of the bill were two-fold: first it sought to showcase neglect of LSUHSC-NO-run Charity system hospitals outside of New Orleans. Secondly, it also spotlighted the gap, suggested Cassidy, between the amount allocated in New Orleans and actual services delivered. Indeed, he suggested that potentially more than $280 million was unaccounted for – a contention both LSU officials and New Orleans legislators disputed.

An unintended consequence of the legislation was its potential to up-end the proposed LSU/VA Hospital business plan, something which brought out ferocious opposition from most New Orleans legislators. It easily passed out of the Senate Health and Welfare Committee and the upper chamber by a vote of 27-8 (after LSU Shreveport-run Charity Hospitals were stripped from the bill at the suggestion of north Louisiana lawmakers). Yet it deadlocked in the House Health and Welfare Committee 8-8, before Cassidy reluctantly agreed to turn it into a study bill which retained its provisions but set no deadline for implementation. Making its way to the House chamber, the bill was defeated 61-35, with all New Orleans-area legislators, joined by most north and southwest Louisiana ones leading it to its final defeat.

The battle over SB 402 offered the clearest window of the disposition of potential legislative allies that could be in accord with a reopened Big Charity. While their leading member Senator Joe McPherson (D-Woodworth) remains skeptical regarding “beating the dead horse” of Big Charity, he acknowledged that interim needs also need to be met. Several of his north, central and southwest Louisiana colleagues at once defended their regional LSU-Shreveport hospitals while providing crucial support towards south Louisiana Charity facilities. Legislative funding for the new LSU replacement of Big Charity has been in place since 2004 – yet most of these legislators also backed HCR 89. Future success towards upholding the historic mission of Charity Hospitals statewide rests with these legislators, whatever the outcome of Big Charity in New Orleans.

The 2008 Regular Louisiana Legislative Session did pass some noteworthy healthcare policy. Five bills encompass a more comprehensive mental health care plan for the state, as well as addressing New Orleans’ acute behavioral health crisis in the wake of Hurricane Katrina. In particular SB 228, authored by Senator David Heitmeier (D-New Orleans) provides for the creation of crisis receiving centers, including presumably the restoration of Big Charity’s Crisis Intervention Unit. Other bills in the package, which were soundly supported by the legislature, Governor Jindal, and criminal justice and public safety allies of Louisiana Healthcare Matters include the ability to order a psychiatric patient to receive treatment if they will not do so voluntarily (SB 182, dubbed “Nicola’s law” by Senator Cheryl Gray, D-New Orleans), allowing psychiatrists off-site ability to commit individuals in crisis through telemedicine (HB 653, by John LaBruzzo, R-Metairie) as well as affording such medical malpractice liability coverage (HB 193, by Kay Katz, R-Monroe).

Other noteworthy healthcare legislation passed includes HB 359, authored by Juan LaFonta (D-New Orleans), which requires school boards to provide information about the Human Papilloma Virus (HPV) and the vaccine that prevents cervical cancer to students in grades 6-12, subject to parental consent. HB 1071, authored by Noble Ellington (D-Winnsboro), establishes a program to fund forgiveness of student loans for physicians in rural areas. Additionally seven bills relative to healthcare and services for people with autism received approval, including HB 958 by Representative Franklin Foil (R-Baton Rouge) which mandates health insurance coverage of the diagnosis and treatment of autism spectrum disorders in individuals under 17 years of age.

Several bills also deservedly failed to pass into law, including several proposals to privatize mental health and nursing home services, and the repeal of the motorcycle helmet law. The latter, HB 1295, by MJ “Mert” Smiley, Jr. (R-Port Vincent), had passed out of the House but was soundly rejected in the Senate Health and Welfare Committee, following opposition of former Louisiana State Police Superintendent Colonel Jim Champaigne (who reportedly was dismissed by the incoming Jindal administration for opposing the helmet repeal) and Dr. James Aiken, a LSU University Hospital Chief of Emergency Medicine, who suggested that the hospital lacked the critical care beds necessary to treat injured motorcyclists without helmets.

Then there was the remarkable gubernatorial veto of $500,000 for the Greater New Orleans Bioscience Economic Development District. Governor Jindal said that “although this is a very worthwhile initiative, this organization is eligible to apply for matching grant funds from the Louisiana Department of Economic Development or funding from local sources.” A prime promoter of the demolition of the Lower Mid-City neighborhood for the proposed LSU/VA Hospital, GNOBEDD will now have to reapply for funds – opening itself up to justified public scrutiny.

Funding for the Charity Hospital system remained mostly intact in legislative appropriations, after earlier proposed cuts. The LSU Business Plan for a new hospital to replace Big Charity was sanctioned by Jindal’s Department of Health and Hospitals a few days prior to the end of the session. Critics of the Charity system, including the bourbon-backed Public Affairs Research Council (PAR), suggested that this outcome as well as the lack of other “reform” measures left “the state’s monumental problem with healthcare essentially untouched.” So too went the insurance voucher proposal by the Coalition of Louisiana Leaders for Healthcare (COLLAH). It received an early drubbing in the Senate Health and Welfare Committee, with the legislature’s dean of healthcare policy, Senator Joe McPherson questioning both its core assumptions and financing for them, which he said would leave Louisiana without a healthcare safety net.

Governor Jindal said July 7 that he would not call another special legislative session this year unless there is an extraordinary situation such as another hurricane. According to published news reports, Jindal said that he will however focus upon healthcare and the economy in the coming months, pledging to make executive changes and potentially plan for an early-2009 healthcare special session. It may be then that the full impact of his decidedly reserved legislative response to date will become fully apparent – and give advocates of healthcare for all and for reopening Big Charity time to organize.

Thursday, July 3, 2008

This Op-Ed by Richard Moe, President of the National Trust for Historic Preservation appeared in the July 3 edition of the Times-Piayune.

A year ago, USA Today told its readers about a feisty Mid-City resident named Bobbi Rogers. Back then, Ms. Rogers was excited about getting started on the renovation of her flood-damaged house. Today, she's dismayed because her home, now beautifully refurbished, is threatened with demolition.

The threat to Ms. Rogers' home -- and many other structures in her neighborhood -- arises from a plan to build a new Veterans Administration medical facility and a 424-bed teaching hospital to replace Charity Hospital, which has been shuttered and moldering since Hurricane Katrina. The plan, which was recently given the go-ahead by Gov. Bobby Jindal and Secretary Alan Levine of the Department of Health and Hospitals, would destroy 150-200 homes and businesses.

In other words, people who saw their homes swamped by rising floodwaters could now see them flattened by roaring bulldozers.The seriousness of the threat led the National Trust for Historic Preservation to include Charity Hospital and the adjacent historic neighborhood on its 2008 list of America 's 11 Most Endangered Historic Places.

The listing spotlights our alarm over the possible loss of "Big Charity," which is New Orleans ' premiere example of Art Deco design, and a major part of the Mid-City Historic District, which is listed in the National Register of Historic Places. It also reflects our concern that plans for constructing the new medical facilities are being pushed too fast, before all the facts are in.

As mandated by a resolution of the state Legislature in 2006, an assessment of the Charity Hospital building is currently being carried out under the direction of the Foundation for Historical Louisiana; the final report on the structural condition of this important landmark is expected to be released by mid-August. The information in this report should be a major factor in -- not an afterthought to -- any decision about the need to construct new hospitals.

Similarly, the destruction of part of the historic Mid-City neighborhood and the displacement of its residents should not be contemplated until there has been a full and open discussion of the reasoning behind a decision that will impact hundreds of families. Up to now, most New Orleanians -- including the owners of property within the proposed footprint of the new hospitals -- have learned about the project primarily through the media. That's wrong. When residents are facing the threat of removal from their neighborhood, they shouldn't be expected to comply meekly, with no explanation of why they are being uprooted.

The National Trust urges the New Orleans City Council, the city's Office of Recovery and Development Administration, the Regional Planning Commission, LSU and the VA to open up the process. When site selection and facility design proceed in a manner that is contrary to established guidelines for historic preservation and environmental reviews the public is understandably left with the impression that federal, state and local agencies are merely going through the motions of compliance.

We all deserve better than this. Specifically, we deserve meaningful discussion of alternative sites within New Orleans, a rationale for the choice of the Mid-City location and a discussion of the extraordinary size of the proposed footprint.

No one disputes that New Orleans needs top-quality, 21st-century facilities for health care, medical education and research. But meeting this need doesn't have to involve the needless sacrifice of a historic neighborhood whose residents have already demonstrated their determination to put Katrina behind them and rebuild their lives in the area they love. If the new medical facilities are truly needed, there are viable alternative sites for them -- sites that won't force people to choose between shiny hospitals and familiar homes.

This letter, written by the Executive Vice Chair of the Foundation for Historic Louisiana, was sent to various state officials including Governor Bobby Jindal and printed in June 5 edition of the Times-Picayune.

The Foundation for Historical Louisiana, pursuant to its charge in HCR 89, has recently hired the firm of RMJM Hillier to do an independent assessment of Big Charity Hospital. RMJM Hillier is an internationally renowned architectural firm that specializes in both preservation and state of the art healthcare design. Due to be completed by August 21, this in-depth evaluation will be the first study to determine the structural integrity of this building and the possibilities of restoring and renovating Charity to a first rate medical facility.

Charity Hospital has been a part of Louisiana’s architectural, cultural and medical heritage for 272 years. Last week the National Trust for Historic Preservation listed the hospital and its adjacent neighborhood as one of America’s 11 most treasured and endangered sites. Since its closing there have been several assessments of the hospital, but only to determine the monetary amount of damages to be reimbursed by FEMA. There has been no study to determine the viability and reuse potential of this monumental landmark. That is until now.

The Foundation has worked diligently to fulfill the charge unanimously passed by the 2006 Legislature in House Concurrent Resolution 89. HCR 89 provided no appropriation, thus the study is being funded by the Foundation for Historical Louisiana and donors. We are proud to have been chosen to lead this fact finding mission to provide the first independent assessment of the building and to determine its viability for any future medical use. With the cooperation of the State Office of Facility Planning and LSU, RMJM Hillier has begun this critical evaluation to gather the full data.

We ask that all decisions concerning Charity Hospital and/or a proposed new hospital, which will demolish over 25 blocks of historic homes and businesses in a National Register of Historic Places neighborhood, be put on hold until we have the results from this assessment of a Louisiana icon. Our findings will be issued to the full Legislature, LSU Board of Supervisors, State Office of Facility Planning, and Louisiana Recovery Authority by August 21, 2008.

Should you have any questions, please feel free to contact me at 225-445-3800.